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ACUTE SINUSITIS 67
While the original virus infection does not respond to antibiotics the
secondary invaders are usually antibiotic-sensitive. In the absence of a
specimen of the mucopus, which may be obtained either with a throat swab in
the nose, which may cause pain on touching the inflamed mucosa, or by
blowing the nose into a sterile swab and taking a specimen from this, a
broad-spectrum antibiotic such as ampicillin should be given in full doses for
7 days. If a sample of the pus is obtained and cultured the appropriate
antibiotic should be prescribed if the strain is resistant to ampicillin.
Fig. 28. Acute left maxillary sinusitis showing Fig. 29. Fluid level in the left maxillary sinus,
Decongestion of the inflamed oedematous mucosa is achieved by nasal
drops or spray of 1 per cent ephedrine hydrochloride either alone or in
combination with 1 per cent silver protein (Argotone). Steam inhalations of
menthol crystals or of a 20 per cent alcoholic solution of menthol should be
used some 10-15 minutes after the decongestant spray, as this allows a
greater penetration. It is important in acute infections that these inhalations
are not too strong, three crystals or 1 ml of the solution being sufficient in a
pint (0-5 1) of water at 70 °C.
Analgesics may be required in the acute stage, and in very severe pain an
injection of morphine may be necessary.
These measures are usually sufficient to result in a cure. Once the infection
is controlled and drainage established the sinus generally clears itself of
infected mucopus which is got rid of by nose blowing. The patient must be
warned against too vigorous blowing of the nose in case the auditory tubes
become involved and otitis media results.
Surgery is rarely necessary in the acute phase, nor is it desirable to operate
through acutely inflamed bone. In some cases treatment of an acute sinusitis
is not pursued with sufficient thoroughness, and occasionally it is unsuccessful.
In such events a limited drainage operation may be considered necessary.
The ostium of the maxillary sinus is unfavourably placed in the upper part of
the medial wall so that drainage is difficult and infection may be retained